AccountId: 011433970860
ContactId: 8320500b-1a91-4b05-a29c-f03418062ef6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 355239 ms
Total Talk Time (AGENT): 93553 ms
Total Talk Time (CUSTOMER): 165719 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/8320500b-1a91-4b05-a29c-f03418062ef6_20250214T17:53_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII]. I have a policy and a claim here that I'd like to go over with you. Can you spell your first name?
[AGENT][NEUTRAL] Sure, it's [PII], last initial [PII] And Ms. [PII], what is your policy number, please?
[CUSTOMER][NEUTRAL] I'm a provider.
[AGENT][NEUTRAL] OK, what is the policy number?
[CUSTOMER][NEUTRAL] This 246-228-0.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] This is for [PII], date of birth [PII].
[AGENT][NEUTRAL] OK. And you say you have a claim or you checking claim about a claim that was processed for her?
[CUSTOMER][NEUTRAL] So, so.
[CUSTOMER][NEUTRAL] First, I'd like to verify her coverage. Does she have medical under this policy?
[AGENT][NEUTRAL] Uh, it is a medical policy. It's a secondary supplemental, uh, it's used to help with primary insurance deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] So this is a secondary insurance.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And what is the effective date on this policy?
[AGENT][NEUTRAL] Uh, her effective date is [PII].
[CUSTOMER][NEUTRAL] [PII] to current, right? And you guys are secondary?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Well, the policy term [PII] this, uh, this year, and we are secondary, yes, ma'am.
[CUSTOMER][NEUTRAL] I'm sorry. So what is her effective date then?
[AGENT][NEUTRAL] [PII], policy terminates [PII].
[CUSTOMER][NEUTRAL] OK, so she termed already. Um, and you guys are secondary, so the claims address is
[CUSTOMER][NEUTRAL] Is it APL or do we have to spell out the whole name of the insurance?
[AGENT][NEUTRAL] No, it's APL.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] [PII] and I have a payer ID number 60801, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, you get, so can you see about this claim, um, it looks like you guys processed it and denied it for non-cover charges. Is that because you guys.
[AGENT][NEUTRAL] OK. What was
[AGENT][NEUTRAL] What was the date of service and the amount of the charge?
[CUSTOMER][NEGATIVE] It is for, hold on, my system's moving just a little too slow.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, [PII], sorry, [PII] for $470.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And you're calling from?
[CUSTOMER][NEUTRAL] Northwestern Medical Faculty Foundation.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, it looks like initially the claim process is needing primary IB and we received it a second time and then uh process has to duplicate.
[CUSTOMER][NEUTRAL] OK. So you guys are secondary. What, do you have the primary insurance information? Because at one point, the patient did have Humana.
[CUSTOMER][NEUTRAL] But their pol, it looks like their policy term with Humana back in [PII], but I'm gonna confirm that while we're on the phone. Hold on.
[CUSTOMER][NEUTRAL] Do you guys show any other insurance for this patient?
[AGENT][NEUTRAL] Uh, let's see. So like in a group, it was Amed possibly.
[AGENT][NEUTRAL] So you probably have to contact her or because it was through her husband and um verify who their major medical is with because we show Amed.
[CUSTOMER][NEUTRAL] Admed.
[AGENT][POSITIVE] Amed, A V M E D Amed.
[CUSTOMER][NEUTRAL] A V M E D, OK.
[CUSTOMER][NEUTRAL] Uh, I don't know at the top of my head that insurance. Hold on.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] All right, they're probably gonna need to update their COP then because I don't have any other insurance.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Only you guys and Humana, but Humana is already termed.
[CUSTOMER][NEUTRAL] OK. Um, is there a reference number?
[AGENT][NEUTRAL] Uh, no, ma'am. We don't give reference numbers. You may use my name in today's date.
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][POSITIVE] Alright, you're welcome